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Several armed conflicts and military troop interventions have been associated with minor pandemics, however, not always, and with the extent varied. e.g. during the most catastrophic loss of lives in the Bosnian Conflict in 1993-95 where 160,000 civilians and soldiers fell into mass graves, only one small epidemic of Hepatitis A was reported to the European branch of WHO. In contrast, epidemics of cholera in Haiti, not related to war but associated with troop deployment (UN battalion from Nepal) in 2014, led to a devastating epidemic of cholera in the Artibonite River District with 1,000s of deaths. The same was reported during civil war and genocide in Rwanda in 1988-98 where hundreds died, and refugees of war-related exodus from Rwanda to the DRC in Goma. Finally, pipeline and water supply devastation during war in Yemen, led to the largest cholera outbreak in Yemen (1-3). Therefore, fear of epidemics, especially during COVID-19 Omicron wave is of concern mainly when the numbers of positive cases in Austria and other EU countries are increasing. The aim of this study was to report the results of COVID-19 antigen testing in those escaping from war in Ukraine.

Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy.We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI.The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02).The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.

Background We sought to prospectively identify risk factors for biliary complications and 30-day readmission after cholecystectomy for choledocholithiasis and gallstone pancreatitis across multiple US hospitals. Methods We performed a prospective, observational study of patients who underwent same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019 at 12 US centers. Patients with prior history of endoscopic retrograde cholangiopancreatography or diagnosis of cholangitis were excluded. We used logistic regression to determine associations between preoperative demographics, labs, and imaging on primary outcomes: postoperative biliary complications and 30-day readmission. Results There were 989 patients in the cohort. There were 16 (1.6%) patients with postoperative biliary complications, including intra-abdominal abscesses, endoscopic retrograde cholangiopancreatography-induced pancreatitis, and biliary leaks. Increasing operative time (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .02), worsening leukocytosis (odds ratio 1.16, 95% confidence interval 1.07–1.25, P = .0002), and jaundice (odds ratio 3.25, 95% confidence interval 1.01–10.42, P = .04) were associated with postoperative biliary complications. There were 36 (3.6%) patients readmitted within 30 days owing to a surgical complication. A prior postoperative biliary complication (odds ratio 7.8, 95% confidence interval 1.63–37.27, P = .01), male sex (odds ratio 2.42, 95% confidence interval 1.2–4.87, P = .01), and index operative duration (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .03) were associated with 30-day readmission. Conclusion Among patients undergoing cholecystectomy for common bile duct stones, jaundice, worsening leukocytosis, and longer operations are associated with postoperative biliary complications. A prior biliary complication is also predictive of a 30-day readmission. Surgeons should recognize these factors and avoid prematurely discharging at-risk patients given their propensity to develop complications and require readmission.

Food supplies are leading priorities during reception and first contact with all refugees of war. The aim of the study was to longitudinally document the clients flow in a food and clothing center at SEUC in Bratislava, serving clients sent from various checkpoints between Ukraine, Slovakia and Poland.

During the first and second wave of Covid-19 pandemics, Balkan countries were among the least affected areas of Europe, especially those having islands as naturally protected quarantine environment (Greece, Croatia, Cyprus, Malta), as well as countries with less tourism in Spring such as Montenegro, Albania, and Bulgaria Therefore, the health care system was not overwhelmed by Covid-19 infected patients and was able to continue on normal outpatient and inpatient bases This pilot population-based study in rural Albania shows only a low and temporary break of health and social services for just 1 month during the first wave, in April 2020

The genocidal war waged by the Nazis has long influenced our understanding of German nationalism. Scholars have argued that the Third Reich was a direct result of German nationalism, which had been antisemitic, racist, militaristic, and anti-democratic from its beginnings. However, as this chapter will highlight, there was never a singular form of German nationalism, especially during the Weimar period. It is certainly true that conservatives and right-wing extremists used this virulent version of German nationalism to attack the Weimar Republic, its supporters, and the post-war international order. Yet German nationalism was not simply the domain of the political right. The supporters of the republic crafted their own form of German nationalism to help them popularize the new political system. Challenging the arguments of their opponents, these republicans insisted that there were no inherent contradictions between democracy and Germany, internationalism and nationalism, and Jews and Germans. They created a version of German nationalism that was democratic, peaceful, and more inclusive. Multiple and opposing German nationalisms therefore existed in the Weimar era.

Background: Surgical task-sharing is a strategy allowing trained mid-level providers to perform essential surgery in low-resource areas. Despite case volumes second only to obstetric surgery, no large-scale comparative study has been previously performed examining task-sharing for acute abdominal surgery. Both general surgeons and mid-level emergency surgical officers (ESOs) perform laparotomies in the same facilities in Ethiopia, presenting an opportunity for comparative analysis of outcomes. Methods: A three-year retrospective study collected surgical case data at 4 general hospitals (n = 1540) with ESOs and MD surgeons, and 2 comparison samples from a primary (n = 100) and a tertiary (n = 142) hospital. Bivariate analysis compared mortality and morbidity stratified by provider type, sub-stratified by facility and twelve categories of emergency abdominal surgery. Multivariable logistic regression modeled the impact of provider training level on odds of perioperative mortality, complication and SSI rates, adjusting for patient age, gender, hospital facility, distance score and preoperative health score. Results: Both overall and within each general hospital across 12 diagnosis categories of emergency abdominal surgery, no significant additional risk was found for ESO mortality, complication and SSI rates. Logistic regression modeling found no additional odds of mortality, complication or surgical site infection for ESOs, controlling for patient age, gender, treatment site, distance travelled, and preoperative health. Conclusion: Emergency surgical officers at general hospitals performed a wide range of abdominal surgery with similar risks of in-hospital mortality, perioperative morbidity and surgical site infection versus similar procedures performed by physician surgeons. Cases performed by ESOs included appendectomy, bowel decompression, bowel resection, perforated peptic ulcer repair, colostomy creation, hemicolectomy, salpingectomy and oophorectomy, and abdominal trauma management with no additional detectable risk. Referral to surgical specialists remains essential in abdominal cases involving liver, spleen, gallbladder, pancreas, and complex vascular or oncological complications. Funding Statement: The funding source for this study was a grant provided by Dr. Mark Hardy, MD, Columbia University Department of Surgery, partially supported by the Il-song Education Foundation and Hallym University Global Medicine Program. Declaration of Interests: The authors have no financial conflicts of interest to disclose. Ethics Approval Statement: Ethical approval was granted by the Columbia University Medical Center Institutional Review Board with a designation of Exempt Research (IRB-AAAR9424) and by the Ethiopian Federal Ministry of Health (Ref. MT(1)/45/300).

To analyze in-room video recordings of operating room (OR) to intensive care unit (ICU) handoffs to determine tempo and quality of team interactions on nights and weekends compared with weekdays, and to demonstrate how existing telemedicine technology can be used to evaluate handoffs.This prospective observational study of OR-to-ICU bedside handoffs was conducted in the surgical ICU of the Hospital of the University of Pennsylvania in July 2014-January 2015. Handoff video recordings were obtained for quality improvement purposes using existing telemedicine cameras. Evaluators used adapted validated in-person assessment measures to analyze basic characteristics and quality measures (timing, report types, report duration, presence of physical exam, teamwork skills, engagement, report delivery skills, listening skills, interruptions, unprofessional comments or actions).Sixteen weekday and 16 night and weekend handoffs were compared. There were no significant differences in basic characteristics. Most quality measures were similar on weekdays compared with nights and weekends. Surgeons demonstrated better report delivery skills and engagement on nights and weekends (P = .002 and P = .04, respectively), whereas OR anesthesiologists' scores were similar during both time frames.This study presents a novel approach of assessing handoff quality in OR-to-ICU handoffs using an existing telemedicine infrastructure. Using this approach, quality measures of night and weekend handoffs were found to be no worse-and sometimes better-than those during weekdays. Video analysis may emerge as an ideal unobtrusive quality improvement methodology to monitor handoffs and improve education and compliance with institutional handoff policies.

Operating room (OR) to intensive care unit (ICU) handoffs are complex and known to be associated with adverse events and patient harm. The authors hypothesized that handoff quality diminishes during nights/weekends and that bedside handoff practices are similar between ICUs of the same health system. Bedside OR-to-ICU handoffs were directly observed in 2 surgical ICUs with different patient volumes. Handoff quality measures were compared within the ICUs on weekdays versus nights/weekends as well as between the high- and moderate-volume ICUs. In the high-volume ICU, transmitter delivery scores were significantly better during off hours, while other measures were not different. High-volume ICU scores were consistently better than those in the moderate-volume ICU. Bedside handoff practices are not worse during off hours and may be better in ICUs used to a higher patient volume. Specific handoff protocols merit evaluation and training to ensure consistent practices in different ICU models and at different times.

This book looks at the questions of state- and nation-building in interwar Central Europe. Ever since Hitler annexed his native Austria to Germany in 1938, the term “Anschluss” has been linked to Nazi expansionism. The legacy of Nazism has cast a long shadow not only over the idea of the union of German-speaking lands but also over German nationalism in general. Due to the horrors unleashed by the Third Reich, German nationalism has seemed virulently exclusionary, and Anschluss inherently antidemocratic. However, as the text makes clear, nationalism and the desire to redraw Germany's boundaries were not solely the prerogatives of the political right. Focusing on the supporters of the embattled Weimar and First Austrian Republics, this book argues that support for an Anschluss and belief in the großdeutsch idea (the historical notion that Germany should include Austria) were central to republicans' persistent attempts to legitimize democracy. With appeals to a großdeutsch tradition, republicans fiercely contested their opponents' claims that democracy and Germany, socialism and nationalism, Jew and German, were mutually exclusive categories. They aimed at nothing less than creating their own form of nationalism, one that stood in direct opposition to the destructive visions of the political right. By challenging the oft-cited distinction between “good” civic and “bad” ethnic nationalisms and drawing attention to the energetic efforts of republicans to create a cross-border partnership to defend democracy, the book emphasizes that the triumph of Nazi ideas about nationalism and politics was far from inevitable.

Long Hartmann or rectal stump blowout is a dreaded complication of an often already complicated patient scenario. In this chapter, we discuss strategies for stump blowout prevention, diagnosis, and management.

This introductory chapter illustrates that there were multiple understandings of Germanness during the Weimar era, hence emphasizing how the triumph of Nazi ideology after 1918 was far from certain and pointing out how historical understandings of Nazism has overlooked the vital historical relationship between Germany and Austria. It examines the state of Germany in both the nineteenth century and the immediate postwar situation, from which the more contemporary contests that emerged between republicans and their opponents over the nature of German nationalism and politics that this book studies had emerged. The chapter contextualizes the shifting boundaries of Germanness against this backdrop, at the same time highlighting the long-neglected connections between Germany and Austria and the importance of exploring the exchange of people and ideas across the Austro-German boundary.

This concluding chapter discusses the subsequent Nazi appropriation of the Anschluss and briefly recounts the differences between the republican and Nazi ideas about an Anschluss and nationalism. It expands on the republican use of großdeutsch nationalism: in allowing diverse groups to participate in a national community that was compatible with a democratic and pluralistic society, großdeutsch nationalism became a critical aspect in republicans' energetic attempts to legitimize the embattled republics. While it is true that republicans on both sides of the Austro-German border were never able to convince the political right that they were loyal Germans or that parliamentary democracy was a German form of government, the chapter argues that their inability to do so does not mean that their attempts to create a democratic and peaceful großdeutsch nationalism should be dismissed.

This chapter examines the politics of the most prominent Anschluss organization of the era, the Österreichisch-Deutscher Volksbund (Austro-German People's League). Marketing itself as a “nonpartisan” association, the Volksbund included the supporters and opponents of democracy, Jews and anti-Semites, Catholics and Protestants, blue-collar workers and the middle classes. Focusing on the association's activities, this chapter investigates how these disparate groups could collaborate even as they were riven by political battles that emerged both within and about the association. It also explores the radical changes that affected the association after the 1933 Nazi seizure of power, thereby highlighting the fact that there was no straight line between 1918 and 1938.

This chapter looks at cultural commemorations for the anniversaries of the deaths of Ludwig van Beethoven in 1927, Franz Schubert in 1928, Walther von der Vogelweide in 1930, and Johann Wolfgang von Goethe in 1932. It explores how Germans and Austrians used these festivals to stage a transborder German community in the interwar period. They hoped that a focus on culture, rather than politics, would help them overcome the sociopolitical fragmentation of the interwar years. At first glance, these cultural celebrations appeared to bridge the numerous divisions running through both societies, as people from various social and political backgrounds wanted to honor these German cultural heroes. Nonetheless, political fights broke out among participants as they interpreted the lives and impact of these cultural figures according to their own divergent worldviews. By investigating these disagreements, this chapter underscores the numerous understandings of Germanness in the Weimar era.

This chapter examines the efforts to create a republican holiday in each state. Although republicans in Germany were never able to declare an official state holiday, they managed to stage a de facto republican celebration that included Germans from different political, social, and religious backgrounds. In Austria, the situation regarding a holiday presented the opposite scenario. The Austrian National Assembly easily passed a law creating a holiday to commemorate the founding of the republic, but the yearly commemoration only served to reinforce the divisions between the socialist and Catholic parties in Austria. These different political contexts also explain why the Austro-German republican partnership included socialists, left liberals, and Catholics in Germany and only socialists in Austria.

This chapter examines republicans' rhetorical defense of the republics. Countering claims by the political right that the new republics were un-German, republicans argued that parliamentary democracy and German nationalism were not at odds. To prove their point, they cited the revolution of 1848 and their support for an Anschluss, or a political union between Germany and Austria. In doing so, republicans attempted to create their own form of nationalism by contrasting their großdeutsch nationalism with right-wing alldeutsch (pan-German) nationalism and conservative nationalism. Even though republicans at times harbored prejudices, they used großdeutsch nationalism to support democratic rights and practices, to reconcile national and international allegiances, and to create a national community that cut across religious, political, and social divisions.

This chapter investigates the use of cross-border visits and motifs in political commemorations and rallies. In particular, it looks at the relationship between the Reichsbanner Schwarz-Rot-Gold and the Republikanischer Schutzbund. Highlighting the ability of republican großdeutsch nationalism to mobilize popular support, thousands of members of the two associations traveled across the border to attend pro-republican festivities, where they received an enthusiastic reception from local populations. Yet this cross-border relationship was not without problems. The Austrian socialists' revolutionary rhetoric and attacks on their Catholic political opponents at home stirred tensions between the two republican organizations. These disagreements, however, did not simply originate within the republican coalition. Conservatives and the radical right in both states endeavored to break up the republican alliance. The political right's effort to do so was a sign of the importance of the cross-border republican partnership to the defense of democracy.

This chapter addresses the clash over state symbols that emerged alongside the intensive debates about the new form of government. It highlights the importance of großdeutsch nationalism in republican attempts to defend democracy and its symbolic manifestations. In the Weimar Republic, the decision by the National Assembly to replace the black-white-red imperial standard with a black-red-gold tricolor was hotly contested by those on the political right. For Austrians, the debate over state symbols focused on the national anthem. This chapter, however, moves beyond simply viewing these debates as symptoms of political fragmentation in the two countries. Through an investigation of letters and petitions sent by individuals and associations to the governments, it explores how contemporaries began self-consciously to practice what they saw as the rights and responsibilities of citizens living in democratic republics.

Operating room (OR) to intensive care unit (ICU) handoffs are complex and known to be associated with adverse events and patient harm. The authors hypothesized that handoff quality diminishes during nights/weekends and that bedside handoff practices are similar between ICUs of the same health system. Bedside OR-to-ICU handoffs were directly observed in 2 surgical ICUs with different patient volumes. Handoff quality measures were compared within the ICUs on weekdays versus nights/weekends as well as between the high- and moderate-volume ICUs. In the high-volume ICU, transmitter delivery scores were significantly better during off hours, while other measures were not different. High-volume ICU scores were consistently better than those in the moderate-volume ICU. Bedside handoff practices are not worse during off hours and may be better in ICUs used to a higher patient volume. Specific handoff protocols merit evaluation and training to ensure consistent practices in different ICU models and at different times.

Heparin-induced thrombocytopenia (HIT) is a common drug induced autoimmune condition. The thrombocytopenia is caused in most cases by an antibody directed against the complex PF4/heparin. Recently, we have induced an experimental model of HIT by idiotypic manipulation. To confirm further the idiotypic involvement of HIT, we have treated successfully three patients with HIT with high-dose intravenous γ-globulin (IVIG). Our three patients join other two cases previously reported who were treated with IVIG and point to the efficacy of this type of therapy with minimal side effects. IVIG suppression of the anti-PF4/heparin autoantibody may support the idiotypic etiology of HIT.

RESULTS: A total of 315,400 records were analyzed (Table). Average age was 51.4 ( 19.9) years; 65.1% were female. Conversion to open surgery occurred in 0.3% (n1⁄41,023) of cases. Riskadjusted odds of conversion increased by 14% (95% CI 1.131.15) for each day that surgery was delayed. Risk-adjusted costs per patient were 122% higher (absolute difference $47,800) for patients who underwent conversion (relative 101% increase [absolute difference $41,100] when restricted to acute cholecystitis cases).

The genetic algorithm is applied to developing optimal or near optimal backpropagation neural networks for fault-prone/not-fault-prone classification of software modules. The algorithm considers each network in a population of neural networks as a potential solution to the optimal classification problem. Variables governing the learning and other parameters and network architecture are represented as substrings (genes) in a machine-level bit string (chromosome). When the population undergoes simulated evolution using genetic operators-selection based on a fitness function, crossover, and mutation-the average performance increases in successive generations. We found that, on the same data, compared with the best manually developed networks, evolved networks produced improved classifications in considerably less time, with no human effort, and with greater confidence in their optimality or near optimality. Strategies for devising a fitness function specific to the problem are explored and discussed.

In this empirical study, from a large data set of software metrics for program modules, thirty distinct partitions into training and validation sets are automatically generated with approximately equal distributions of fault prone and not fault prone modules. Thirty classification models are built for each of the two approaches considered-discriminant analysis and the evolutionary neural network (ENN) approach-and their performances on corresponding data sets are compared. The lower error proportions for ENNs on fault prone, not fault prone, and overall classification were found to be statistically significant. The robustness of ENNs follows from their superior performance on the range of data configurations used. It is suggested that ENNs can be effective in other software reliability problem domains, where they have been largely ignored.

In the Czech Republic a market research was carried out in the year 1997, using a questionnaire campaign, concentrating on the mapping of conditions for the introduction of interactive broadband systems, which would provide potential users, together with voice services, access to the Internet, to services on demand, e.g. VoD, AoD, to electronic shopping, etc. The evaluation included technical furnishings of households and technical readiness of users, the interest in information and, based on analysis of the economical situation in the Czech Republic, also the willingness and ability to pay for services offered. It was concluded that the subscribers of cable television networks represent a prospective group.

Heparin-induced thrombocytopenia (HIT) is a common drug induced autoimmune condition. The thrombocytopenia is caused in most cases by an antibody directed against the complex PF4/heparin. Recently, we have induced an experimental model of HIT by idiotypic manipulation. To confirm further the idiotypic involvement of HIT, we have treated successfully three patients with HIT with high-dose intravenous gamma-globulin (IVIG). Our three patients joint other two cases previously reported who were treated with IVIG and point to the efficacy of this type of therapy with minimal side effects. IVIG suppression of the anti-PF4/heparin autoantibody may support the idiotypic etiology of HIT.

Autopsy findings and studies of pulmonary function, including pulmonary mechanics, air distribution, compliance, resistance, and hemodynamics in the intact animal indicate that anatomic and functional changes in the replanted growing lung do not significantly vary from those reported in adult dogs. Significant functional changes included a marked decrease in oxygen uptake and increased pulmonary vascular resistance. Since an increase in pulmonary vascular resistance was also found in animals without evidence of anatomic anomalies, pulmonary hypertension in these animals must, therefore, be related to factors other than obstruction to flow. Whether or not the increased pulmonary vascular resistance in the replanted lung may be secondary to a lack of regrowth of divided nerves is not clearly established. Lung volume distribution, as well as ventilation distribution, as evidenced by nitrogen washout data, were not significantly effected. Growth of vascular and bronchial anastomoses was slightly reduced, but the anastomotic obstructions found were due to technical error or complications rather than to failure of growth. Left pulmonary growth after replantation continued and was found to be significantly reduced only if complete obliteration of the pulmonary artery occurred.